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Effective October 31, 2025: Clinical Policies

Date: 08/01/25

Wellcare By Allwell has approved policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on October 31, 2025, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Allogeneic Hematopoietic Proginator Cell Therapy

(MC.CP.MP.249)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Removed Omisirge specific language from title of policy due to expanding policy
  • Updated Description of policy to include RegeneCyte and to updated title in the Note referencing the non-Medicare version of policy
  • Added Criteria II. to include medically necessary criteria for RegeneCyte
  • Background updated to include RegeneCyte information to align with updated criteria

Skin and Soft Tissue Substitutes for Chronic Wounds

(MC.CP.MP.185)

Wellcare By Allwell (Medicare)

Policy updates include:

  • Updated verbiage in criteria II.A. for clarity
  • Removed prior criteria II.B
  • Updated verbiage in now criteria II.B. for clarity
  • Removed previous criteria II.D
  • Updated verbiage in now criteria II.C. and D
  • Removed previous criteria II.G. through I
  •  Updated verbiage in now criteria II.E. for clarity
  •  Added not regarding documentation requirements under criteria II
  • Moved HCPCS codes A2009 and Q4304 from table of HCPCS codes that do not support medical necessity to HCPCS codes that do support medical necessity

To review all policies, please visit Medicare Prior Authorization Clinical Policies webpage.

Prior to updates, the policies were approved for use by the Medicare Quality Committee.

For questions or additional information, please contact Wellcare By Allwell Provider Services at HMO: 1-800-977-7522 DSNP: 1-877-935-8023.